- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.69 / $254.58 / $418.33
| Professional | | $147.69 | $254.58 | $418.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.65 / $268.76 / $399.18
| Professional | | $196.65 | $268.76 | $399.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.17 / $287.30 / $444.44
| Professional | | $232.17 | $287.30 | $444.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $315.10 / $396.42
| Professional | | $32.34 | $315.10 | $396.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.01 / $234.73 / $380.73
| Professional | | $223.01 | $234.73 | $380.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.39 / $311.52 / $481.45
| Professional | | $236.39 | $311.52 | $481.45 |